Posterior retroperitoneoscopic adrenalectomy (PRA) in adrenocortical carcinoma (ACC).

INTRODUCTION

Investigating the role of posterior retroperitoneoscopic adrenalectomy (PRA) for the treatment of adrenocortical cancer (ACC).

METHODS

Between January 2010 and December 2024, 28 patients (9 men, 19 female) with am mean age of 51.5 ± 19.5 years (range: 1.6-82.3) underwent PRA for primary ACC. Tumor sizes ranged between 3 and 15 cm (mean: 7.3 cm). Hormonal hypersecretion was found in 12 patients. Surgeries were performed in a standardized 3-port technique in prone position. Follow-up (mean: 37.9 months) data could be obtained for 26 patients.

RESULTS

There were 12 right and 16 left adrenalectomies. The mean operating time was 159.2 ± 100.9 min (range: 35-340 min). Seven conversions occurred (25%): five to an open approach and two to a laparoscopic approach. One patient with Cushing's syndrome died because of multiple organ failure in the postoperative period (4%). The mean follow-up time was 38.8 ± 35.3 months. Patients with stage I disease demonstrated a 5-year overall survival rate of 100%, whereas patients with stage II and III disease had 3-years survival rates of 64% and 50%, respectively.

CONCLUSIONS

The posterior retroperitoneoscopic approach appears feasible in patient with confirmed or suspected ACC and can be proposed in selected cases.